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594 Impact of the covid pandemic on gynaecological cancer surgery – results from the covidsurg gynaecological cancer international study
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  1. Sudha S Sundar1,
  2. Elaine Leung1,
  3. Tabassum Khan2,
  4. James Glasbey1,
  5. Nadeem Abu-Rustum3,
  6. Luis M Chiva4,
  7. Anna Fagotti5,
  8. Keiichi Fujiwara6,
  9. Rahel Ghebre7,
  10. Murat Gultekin8,
  11. Thomas Konney9,
  12. Joseph Ng10,
  13. Rene Pareja11,
  14. Rajkumar Kottayasamy Seenivasagam12,
  15. Jalid Sehouli13,
  16. Ts Shylasree14,
  17. Aneel Bhangu1,
  18. Christiana Fotopoulou15,
  19. Covidsurg Cancer Collaborators16
  1. 1University of Birmingham; Institute of Cancer and Genomic Sciences; University of Birmingham
  2. 2University of Birmingham; Nihr Global Health Research Unit on Global Surgery
  3. 3Memorial Sloan Kettering Cancer Center
  4. 4Clínica Universidad de Navarra
  5. 5Catholic University of the Sacred Heart; Fondazione Policlinico A. Gemelli
  6. 6Saitama Medical University; International Medical Center
  7. 7University of Minnesota; Department of Obstetrics, Gynaecology and Women’s Health
  8. 8Hacettepe University Faculty of Medicine; Department of Obstetrics and Gynaecology
  9. 9Kwame Nkrumah University Of Science and Technology; Komfo Anokye Teaching Hospital
  10. 10National University Cancer Institute; Division of Gynecologic Oncology
  11. 11Clinica de Oncología Astorga; Gynaecologic Oncology
  12. 12All India Institute of Medical Sciences; Obstetrics and Gynaecology
  13. 13Charité Universitätsmedizin Berlin; Klinik für Gynäkologie; Charité Universitätsmedizin Berlin
  14. 14Tata Memorial Hospital; Department of Gynecologic Oncology and Mdt
  15. 15Imperial College London
  16. 16Nihr Global Health Research Unit

Abstract

Introduction/Background Covid-19 has resulted in significant number of elective surgeries being delayed or cancelled worldwide with an estimated 28 million patients being affected.1

Studies show that perioperative Covid-19 infection has a high perioperative mortality of 23·8%. (2) Complications increase with any additional treatment burden such as cytotoxic chemotherapy, radiotherapy or immunotherapy.3 In an effort to reduce treatment related morbidity and mortality during the Covid-19 pandemic, many elective anticancer treatments have been postponed or modified.4

Methodology We investigated the impact of the Covid-19 pandemic on gynaecological cancer surgery in an international prospective multi-centre study. Participating centres entered consecutive patient’s data into a customized electronic database for 12 weeks from the first COVID positive patient managed in their hospital between March and June 2020. Patients were eligible for enrollment if they were planned to undergo surgery during the study duration, regardless of COVID-19 status and whether they underwent surgery as recommended or not. Patients who did not undergo their planned surgery were followed up for 12 weeks to observe outcomes. Descriptive analysis of outcomes is presented.

4490/4472 (95%) patients received surgery; of these 17% (n=758) experienced change or adaptation of surgery. The main impact was on surgical timing; 11% ( n=483) experienced delay in surgery, 3% (n=119) a change in choice of operation, 10% (n=452) received surgery in alternative hospital.

Patients in this study had confirmed resolved COVID-19 prior to surgery in 0.95% (n=45) patients with an additional 0.34% (n=16) with probable resolved COVID-19 infection. A post-operative COVID-19 rate of 2.27% (n=25) and pulmonary complication rate of 1.8% (n=20) was found in the initial analysis of the Covidsurg cancer data, analysing outcomes for 1102 gynaecological cancer patients. The overall 30-day mortality rate in this cohort was 1.18% (n=13).5

View this table:
Abstract 594 Table 1

Table Showing participating countries and number of patients entered into the study

Conclusion The largest multi-centre analysis of gynaecological cancer surgery during the Covid-19 pandemic has demonstrated significant adjustments of timing, indications and radicality of surgery in an effort to reduce COVID-19 related complications and has exposed constraints, even in high income countries. Nevertheless, perioperative pulmonary complications and death rates of COVID-19 affected operated women were overall low compared to data reported for other cancers. Failsafe systems are urgently needed to ensure continuity of high standard oncologic care to preserve cancer survival.

References

  1. Covidsurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. BJS 107(11).

  2. Covidsurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet. 2020 Jul 4;396(10243):27–38.

  3. Giorgio Bogani N, Antonino Ditto, Sara Bosio, Claudia Brusadelli, Francesco Raspagliesi Cancer patients affected by COVID-19: Experience from Milan, Lombardy; Gynecologic Oncology; June 2020.

  4. Olivia D Lara, Roisin E O’Cearbhaill, Maria J Smith; Megan E Sutter, Anne Knisely, Jennifer McEachron, Lisa R Gabor, Justin Jee, Julia E Fehniger, Yi-Chun Lee, Sara S Isani, Jason D Wright, and Bhavana Pothuri. COVID-19 Outcomes of patients with gynecologic Cancer in New York City.ACS journals.

  5. James C Glasbey, Aneel Bhangu, and on behalf of the COVIDSurg Collaborative. Elective Cancer Surgery in COVID-19–Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study. Journal of Clinical Oncology 0 0:0.

https://doi.org/10.1136/ijgc-2020-ESGO.218

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